If your arthritis pain has become so disruptive that you’re considering hip replacement surgery, you’re in for some good news. Whereas this procedure — formally called hip arthroplasty — once involved significant hospital stays and recovery time, advances have improved the experience so much that doctors often hear their post-operative patients say they wish they would have done it sooner.
“Hip replacement surgery is probably one of the most successful procedures in all of medicine today,” says Joseph D. Zuckerman, MD, FAOA, professor and chair of the NYU Langone Health Department of Orthopedic Surgery.
Still, as with many conditions, hip replacement surgery for arthritis is often considered only after more conservative treatments have failed.
“You start by treating the pain,” says Dr. Zuckerman, who explains that doctors typically begin with measures such as activity modification, anti-inflammatory medications, physical therapy, and cortisone injections. “But when the pain or disability becomes so significant that these measures aren’t effective, it’s often time to consider surgery.”
That was certainly the experience for Lois W., a 64-year-old patient who had been tolerating arthritis pain in both hips for years when the discomfort finally became too disruptive to handle.
“It got so bad every step I took was painful. I was limited in what I could do in Pilates class, and when I sat on the floor I couldn’t cross my legs,” says Lois, who visited an orthopedist in the summer of 2018. “After he looked at my X-rays he said he didn’t know how I was walking because my hip joint was ‘bone on bone.’” When he recommended she get hip replacement surgery, she interviewed a number of surgeons and scheduled the procedure for a few months later.
What to Expect in the Hospital
The first piece of good news about hip replacement surgery is the significant amount of improvement to the hospital experience in recent years.
“Total hip replacement in 2019 has come a long way from just 10 years go,” says P. Maxwell Courtney, MD, assistant professor of orthopaedic surgery at the Rothman Orthopaedic Institute at Thomas Jefferson University Hospital in Philadelphia. “Back when I was in residency training, this surgery meant a week in the hospital followed by a week in rehab, with morphine. That’s all changed now.”
While the details of hip replacement procedures vary, patients typically come to the hospital in the morning, undergo a medical evaluation, and meet with the surgeon and anesthesiologist. There are many ways of performing the operation itself with variation regarding the incision location and the types of materials used for the replacement joint.
But in general, the procedure may involve sedation with regional anesthesia (like an epidural administered during labor/childbirth) and a small incision on the side or front of the hip. The ball-and-socket hip joint is replaced with components made of ceramic, plastic, or metal. In the recovery room after the procedure, hip replacement patients are given medications to keep them comfortable by controlling factors such as pain, nausea, and inflammation.
Hip Replacement Recovery Starts Right Away in the Hospital
While the recovery experience can play out differently for different people, it can be helpful to approach the overall process in steps.
“I think of recovery in three phases,” says Michael L. Parks, MD, associate professor at the Hospital for Special Surgery in New York City. “I tell patients that my surgery is 20 to 40 percent of the overall recovery process; the rest is their hard work.”
That work generally starts the same day as surgery.
Phase one of recovery, Dr. Parks explains, begins within the first few hours after the procedure, when some patients dangle their feet over the bed, and younger, stronger patients may get up and walk. “This first recovery phase is about realizing, ‘I’ve made it through the procedure, I’m okay, and everything is working,’” says Dr. Parks. “Every one of my patients who came to the hospital for surgery this morning has stood up, moved their legs, and gotten over their pre-operative fears by late this afternoon.”
Dr. Courtney takes a similar approach: “Our patients are up and walking the same day as surgery; sometimes they’re even doing stairs the same day,” he says.
This was certainly Lois’s experience: “Maybe a half hour after recovery I was up walking with a walker, and my first words were, ‘I have no pain!’” she remembers. “The next day they had me doing stairs.”
The second phase of recovery, as Dr. Parks explains it, is returning to daily activities, such as walking to the refrigerator, using the bathroom, and climbing the stairs. “Tomorrow the hard work will begin for the patients who had their procedures today,” he says. This second phase can take four to six weeks, with younger, stronger patients sometimes getting through it in one to two weeks.
Kassie C. was a 75-year-old dental hygienist at the time of her spring 2018 hip replacement. Her inpatient physical therapy involved using occupational equipment that helped her practice at-home activities like getting into a car or entering the tub. “My husband acted as my coach, so he paid attention to all the physical therapists’ instructions and helped me remember how to do things later.”
Barring any complications, discharge after hip replacement surgery can happen fairly quickly.
“Most patients spend one night in the hospital then go home,” says Dr. Courtney. “Some patients who are younger and healthier with social support may even go home the same day.”
Hip Replacement Recovery Continues at Home
Some patients, depending on circumstances, will go to a rehab facility for a few days or weeks before returning to live at home. This may be the case for people who live alone and don’t have caregiving support, or who have factors that could complicate their recovery.
For many others, it’s perfectly safe to return to the familiarity of home straight from the hospital after your hip replacement. You’re still in the second phase of recovery as you re-acclimate to daily life around the house.
Patients walk with assistive devices, such as a walker or cane, during this time. Dr. Courtney anticipates the majority of people will need a walker for a couple of days, then a cane for a couple of weeks. “Most people are walking without assistive devices at four to six weeks,” he says. With the help of a home nurse and physical therapist, Lois remembers switching from walker to cane four days after leaving the hospital.
“At six weeks, people across the spectrum are walking smoothly, feeling better,” says Dr. Parks.
As for milestones like driving and returning to work, timeframes vary by patient, but in general Dr. Courtney sees people going back to desk jobs in as little as two weeks and to more active jobs (such as construction work) after six.
When it comes to driving, because the last thing to come back after hip replacement surgery is break reaction time, Dr. Courtney sees patients back behind the wheel in an average of three to six weeks, with those whose left hip is replaced driving much sooner. “Get comfortable walking first then try driving around your neighborhood to see how it feels,” he advises. Consider whether you might want to apply for a temporary accessible parking placard to make running errands after hip surgery easier.
Phase three of recovery, as Dr. Parks explains it, is returning to more strenuous activities and exercise. “These are my hikers and bikers,” he says. Returning to such taxing activities can take three to four months.
“In general, patients are 80 to 90 percent better over three to four months,” says Dr. Parks. “And they’ll continue to notice a tiny amount of recovery and small improvements for up to one year.”
Factors That Affect Hip Replacement Recovery
There are a number of factors that could impact how quickly and smoothly your hip replacement surgery recovery may go. One of the biggest is how active you were before surgery. “Speed of recovery depends on pre-operative activity levels,” Dr. Courtney says. “Younger, healthier patients will recover quicker.”
In addition, taking measures before surgery to minimize infection risk will help prevent complications from developing later. “One of the most feared complications is infection, so we make sure patients are optimized before surgery,” says Dr. Courtney. “Overweight people above a certain BMI are at higher risk for infection, so we instruct them to lose weight. We recommend that smokers stop smoking and that people with diabetes make sure their blood sugars are correctly managed.”
Is Physical Therapy After Hip Replacement Necessary?
If you ask a bunch of doctors and arthritis patients whether formal physical therapy after hip replacement surgery is necessary, you get a bunch of answers.
“The amount and duration of formal physical therapy after surgery is variable, and people have different opinions about it,” says Dr. Zuckerman. “But the beauty of hip replacement is that after a few sessions with a physical therapist in which you’re instructed in your exercises, it basically comes down to walking. Unlike knee replacement — which involves a physical therapy focus on range of motion — extended formal physical therapy after hip replacement is not really necessary.”
Dr. Courtney feels much the same way. “Most patients don’t need formal physical therapy after leaving the hospital; the best physical therapy you can do after a hip replacement is just walk,” he says. “In a small subset of older hip replacement patients without social support who may have balance issues, physical therapy makes sense. But for most of our patients, the best thing you can do is walk.”
Physical therapy may be comforting for patients though, who may be nervous about “overdoing” it with their new hip.
Lois considered physical therapy to be a key part of her long-term recovery process. In Kassie’s experience, physical therapy is absolutely essential. “They teach you so many things as basic as how to pick something off the floor without folding your body more than 90 degrees,” she remembers. “I’m sure I would not have been able to progress without therapy.”
For Kassie, physical therapy was also an important source of support and encouragement. “It was very helpful to hear from a physical therapist that you were doing a great job — it really helped to build morale,” she says. “Physical therapy was also a social thing. You weren’t confined to your house while you recovered, and it was encouraging to see other people doing their therapy as well.”
Tips for a Smoother Recovery After Hip Surgery
Both patients and doctors share their perspectives on the big and little things that make recovery progress as easily as possible.
“Be realistic about your expectations. Even with the advances that have improved the patient’s experience, this is still major surgery.” — Dr. Parks
“Don’t wait as long as I did to have it done. I walked with a bad limp before; I don’t limp at all now. I feel like a different person, and I keep telling people it’s like a miracle. If you’re told this is the only way to get better, don’t be afraid of it.” — Patient Lois W.
“I did all the exercises the home physical therapist gave me to a ‘T’ and that helped.” — Patient Lois W.
“If you don’t have a walk-in shower, it’s important to have a bench in the shower [so you can slide your legs in one at a time] and to have a hand-held shower head so you can take a full shower sitting on the bench. I wouldn’t have wanted to stand in a slippery shower while still regaining function.” — Patient Kassie C.
“I had my second hip replacement two months ago. I would recommend having the anterior [front] hip replacement. The recovery is a lot faster and no precautions are put on after the replacement like years ago!” — Patient Lynn S., via Facebook
“Do your research before surgery. My right hip replacement took longer to heal as my surgeon fractured my femur during surgery and caused me extra healing time. My left hip was a breeze with a different surgeon as I was in surgery at 9 AM and out [of the surgery center] by 7 PM with very little physical therapy before leaving. It does make a difference in the surgeon you have. Both were anterior procedures, but the second surgeon was more experienced at the procedure.” — Patient Debra W., via Facebook
“As a nurse and someone who has had a hip and knee replacement, the number one advice is to find an excellent orthopaedic surgeon who specializes in hip and knee replacements. Not all orthopaedic surgeons are good. Do your research and find someone with excellent reviews. Your recovery will be much better overall and in the long term.” — Patient DanCin G., via Facebook
“I’ve had both of my hips replaced in my mid-twenties and again in my late thirties. Best piece of advice I can give is to go into your operation with the strongest leg muscles you can muster. Having existing strength post-op aids in recovery.” — Patient Naomi C., via Facebook
